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Indian Journal of Surgery

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17.01.2022 | Others

General Surgery Training in the USA, UK, and India: a Scrutiny of Strength and Challenges

verfasst von: Gaurav Jain, Chandrakanth Are, Vikesh Agrawal, Pawan Agarwal

Erschienen in: Indian Journal of Surgery | Sonderheft 1/2022

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Abstract

Surgicaltraining programs across the globe have the responsibility of preparing the future generation of surgeons while promoting quality and patient safety. Surgical training differs significantly between countries, which can be based on the requirements of local accrediting bodies, different patient populations, different healthcare delivery systems and cultural and traditional patterns unique to that particular training environment. In this article, we reviewed General surgery residency training in the USA, UK, and India to identify strengths and challenges. We also highlighted salient aspects of training, including duration of the training, resident work-hours, operative opportunities, rotation and supervision, essential skill development, research activity, assessment, and regulation.

McIlhenny C, Kurashima Y, Chan C, Hirano S, Domínguez-Rosado I, Stefanidis D (2018) General surgery education across three continents. Am J Surg 215(2):209–213. https://doi.org/10.1016/j.amjsurg.2017.12.002CrossRefPubMed

Sachdeva AK (2007) The changing paradigm of residency education in surgery: a perspective from the American College of Surgeons. Am Surg 73(2):120–129CrossRef

Fritz T, Stachel N, Braun BJ (2019) Evidence in surgical training - a review. Innov Surg Sci 4(1):7–13. https://doi.org/10.1515/iss-2018-0026CrossRefPubMedPubMedCentral

Barry M (2014) What makes a great resident? The programme director perspective. Curr Rev Musculoskelet Med 7(2):161–163. https://doi.org/10.1007/s12178-014-9205-3CrossRefPubMedPubMedCentral

De Siqueira JR, Gough MJ (2016) Correlation between experience targets and competence for general surgery certification. Br J Surg 103(7):921–927. https://doi.org/10.1002/bjs.10145CrossRefPubMed

Gupta A, Kumar S, Kumar S, Mishra MC, Kumar S (2006) Surgical residency programme: training, teaching, and evaluation in general surgery-a peer opinion poll in five medical colleges in northern India. Indian J Surg 68:310–315

Zarebczan B, McDonald RJ, Foley E, Weber SM (2010) The dying field of general surgery: when do we intervene? J Surg Res 160(1):25–28. https://doi.org/10.1016/j.jss.2009.03.080CrossRefPubMed

Elsey EJ, West J, Griffiths G, Humes DJ (2019) Time out of general surgery specialty training in the UK: a national database study. J Surg Educ 76(1):55–64. https://doi.org/10.1016/j.jsurg.2018.06.011CrossRefPubMed

https://www.pgtimes.in/2013/09/pg-doctors-of-india-must-work-not-more.html, Accessed on 1^st November 2021.

10.

Nundy S (2013) Should surgical residents work shorter hours? Natl Med J India 26(5):285–286PubMed

11.

Mittal V, Kaushik M, Bhullar JS et al (2019) Surgical education (developed vs developing nations), disparities, and future directions: Fulbright Project Survey Report. Indian J Surg 81:383–390. https://doi.org/10.1007/s12262-019-01901-8CrossRef

12.

Ferguson CM, Kellogg KC, Hutter MM, Warshaw AL (2005) Effect of work-hour reforms on operative case volume of surgical residents. Curr Surg 62(5):535–538. https://doi.org/10.1016/j.cursur.2005.04.001CrossRefPubMed

13.

Ahmed N, Devitt KS, Keshet I, Spicer J, Imrie K, Feldman L, Cools-Lartigue J, Kayssi A, Lipsman N, Elmi M, Kulkarni AV, Parshuram C, Mainprize T, Warren RJ, Fata P, Gorman MS, Feinberg S, Rutka J (2014) A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg 259(6):1041–1053. https://doi.org/10.1097/SLA.0000000000000595CrossRefPubMed

14.

Hutter MM, Kellogg KC, Ferguson CM, Abbott WM, Warshaw AL (2006) The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Ann Surg 243(6):864–875. https://doi.org/10.1097/01.sla.0000220042.48310.66CrossRefPubMedPubMedCentral

15.

Macgregor JM, Sticca R (2010) General surgery residents’ views on work hours regulations. J Surg Educ. 67(6):376–380. https://doi.org/10.1016/j.jsurg.2010.07.008CrossRefPubMed

16.

Elsey EJ, Griffiths G, Humes DJ, West J (2017) Meta-analysis of operative experiences of general surgery trainees during training. Br J Surg 104(1):22–33. https://doi.org/10.1002/bjs.10396CrossRefPubMed

17.

American Board of Surgery. Booklet of Information: Surgery (2015 – 2016) https://www.absurgery.org/xfer/BookletofInfo- Surgery.pdf [accessed 1^st November 2021

18.

Beard JD. Objective assessment of technical surgical skills (Br J Surg 2010, 97: 972–987), British J Surg, Volume 97, Issue 7, 2010, Pages 987–988, https://doi.org/10.1002/bjs.7118

19.

Bankhead-Kendall B, Brown CV, Gerola R, Slama E, Ryder A, Uecker J, Falcone J (2020) Case logging habits among general surgery residents are discordant and inconsistent. Am J Surg 219(6):937–942. https://doi.org/10.1016/j.amjsurg.2019.09.001CrossRefPubMed

20.

Collins C, Dudas L, Johnson M, Davenport D, Bernard A, Beck S, Muchow R, Pittman T, Talley C (2020) ACGME operative case log accuracy varies among surgical programs. J Surg Educ 77(6):e78–e85. https://doi.org/10.1016/j.jsurg.2020.08.045CrossRefPubMed

21.

Mizota T, Anton NE, Huffman EM, Guzman MJ, Lane F, Choi JN, Stefanidis D (2020) Development of a fundamentals of endoscopic surgery proficiency-based skills curriculum for general surgery residents. Surg Endosc 34(2):771–778. https://doi.org/10.1007/s00464-019-06827-6CrossRefPubMed

22.

Gonzalez RI, Martinez JM, Iglesias AR, Lo Menzo E, Hutson D, Sleeman D, Livingstone AS, Madan AK (2010) Technical skills rotation for general surgery residents. J Surg Res 161(2):179–182. https://doi.org/10.1016/j.jss.2009.09.009CrossRefPubMed

23.

Agrawal V, Agarwal P, Acharya H, Sharma D (2020) Needs-driven skill training for surgical residents: our first experience in a low-/middle-income country. Trop Doct 50(4):299–303. https://doi.org/10.1177/0049475520937173CrossRefPubMed

24.

Aho JM, Ruparel RK, Graham E, Zendejas-Mummert B, Heller SF, Farley DR, Bingener J (2015) Mentor-guided self-directed learning affects resident practice. J Surg Educ 72(4):674–679. https://doi.org/10.1016/j.jsurg.2015.01.008CrossRefPubMedPubMedCentral

25.

Mattar SG, Alseidi AA, Jones DB, Jeyarajah DR, Swanstrom LL, Aye RW, Wexner SD, Martinez JM, Ross SB, Awad MM, Franklin ME, Arregui ME, Schirmer BD, Minter RM (2013) General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors. Ann Surg 258(3):440–449. https://doi.org/10.1097/SLA.0b013e3182a191caCrossRefPubMed

26.

Speaks L, Helmer SD, Quinn KR, Lancaster J, Blythe M, Vincent KB (2021) Chief resident indirect supervision in training safety study: is a chief resident general surgery service safe for patients? J Surg Educ S1931-7204(21):00187–00182. https://doi.org/10.1016/j.jsurg.2021.07.005CrossRef

27.

George BC, Bohnen JD, Williams RG, Meyerson SL, Schuller MC, Clark MJ, Meier AH, Torbeck L, Mandell SP, Mullen JT, Smink DS, Scully RE, Chipman JG, Auyang ED, Terhune KP, Wise PE, Choi JN, Foley EF, Dimick JB et al (2017) Procedural Learning and Safety Collaborative (PLSC). Readiness of US general surgery residents for independent practice. Ann Surg 266(4):582–594. https://doi.org/10.1097/SLA.0000000000002414 Erratum in: Ann Surg. 2018 Mar;267(3):e63CrossRefPubMed

28.

Ullrich LA, Jordan RM, Bannon J, Stella J, Oxenberg J (2020) The mentor match: a new approach to implementing formal mentorship in general surgery residency. Am J Surg 220(3):589–592. https://doi.org/10.1016/j.amjsurg.2020.01.011CrossRefPubMed

29.

Ananthakrishnan N, Arora NK, Chandy G, Gitanjali B, Sood R, Supe A, Nagarajan S (2012) Is there need for a transformational change to overcome the current problems with postgraduate medical education in India? Natl Med J India 25(2):101–108PubMed

30.

Napolitano LM, Biester TW, Jurkovich GJ, Buyske J, Malangoni MA, Lewis FR Jr (2016) Members of the Trauma, Burns and Critical Care Board of the American Board of Surgery. General surgery resident rotations in surgical critical care, trauma, and burns: what is optimal for residency training? Am J Surg 212(4):629–637. https://doi.org/10.1016/j.amjsurg.2016.07.016CrossRefPubMed

31.

Abraham PJ, Abraham MN, Corey BL, Lindeman B, Chen H (2020) Cross-sectional analysis of global surgery opportunities among general surgery residency programs. J Surg Educ 77(5):1179–1185. https://doi.org/10.1016/j.jsurg.2020.03.017CrossRefPubMed

32.

Agrawal V, Jain G, Agarwal P et al (2021) Specialty rotations during general surgery residency: Indian trainees’ perspective. Indian J Surg 83:1333–1334CrossRef

33.

Brenner BM, De Donno MA (2020) Assessing gaps in surgical oncology training: results of a survey of general surgery residents. J Surg Educ. 77(4):749–756. https://doi.org/10.1016/j.jsurg.2020.01.011CrossRefPubMed

34.

https://www.nmc.org.in/wp-content/uploads/2019/09/MS-Surgery.pdf. Accessed on 1st November 2021.

35.

Lund J (2020) The new General Surgical Curriculum and ISCP. Surgery (Oxf) 38(10):601–606. https://doi.org/10.1016/j.mpsur.2020.07.005CrossRef

36.

Smink DS (2017) Why training in nontechnical skills is essential. Surgery 162(1):182. https://doi.org/10.1016/j.surg.2017.03.015CrossRefPubMed

37.

Nakagawa S, Fischkoff K, Berlin A, Arnell TD, Blinderman CD (2019) Communication skills training for general surgery residents. J Surg Educ 76(5):1223–1230. https://doi.org/10.1016/j.jsurg.2019.04.001CrossRefPubMed

38.

Yule S, Parker SH, Wilkinson J, McKinley A, MacDonald J, Neill A, McAdam T (2015) Coaching non-technical skills improves surgical residents' performance in a simulated operating room. J Surg Educ 72(6):1124–1130. https://doi.org/10.1016/j.jsurg.2015.06.012CrossRefPubMed

39.

Szasz P, Bonrath EM, Louridas M, Fecso AB, Howe B, Fehr A, Ott M, Mack LA, Harris KA, Grantcharov TP (2017) Setting performance standards for technical and nontechnical competence in general surgery. Ann Surg 266(1):1–7. https://doi.org/10.1097/SLA.0000000000001931CrossRefPubMed

40.

Geary AD, Hess DT, Pernar LIM (2019) Resident-as-teacher programs in general surgery residency: context and characterization. J Surg Educ 76(5):1205–1210. https://doi.org/10.1016/j.jsurg.2019.03.004CrossRefPubMed

41.

Han JL, Pappas TN (2018) A review of empathy, its importance, and its teaching in surgical training. J Surg Educ 75(1):88–94. https://doi.org/10.1016/j.jsurg.2017.06.035CrossRefPubMed

42.

Javed MS, Harrison E, Taylor I (2005) The role of research in surgical training. Bull Royal College Surgeons England 85(4):120–123CrossRef

43.

Omigbodun AO (2012) The intersection of research and surgical training. J West Afr Coll Surg 2(1):60–66PubMedPubMedCentral

44.

Andriole DA, Klingensmith ME, Fields RC, Jeffe DB (2020) Is dedicated research time during surgery residency associated with surgeons' future career paths?: a national study. Ann Surg 271(3):590–597. https://doi.org/10.1097/SLA.0000000000003015CrossRefPubMed

45.

Frankel WC, Scott BG, Massarweh NN, Silberfein EJ, Zhang Q, Rosengart TK, LeMaire SA, Trautner BW (2020) A multifaceted research engagement program improved the academic productivity of general surgery residents. J Surg Educ 77(5):1082–1087. https://doi.org/10.1016/j.jsurg.2020.03.028CrossRefPubMed

46.

Orkin BA, Poirier J, Kowal-Vern A, Chan E, Ohara K, Mendoza B (2018) Effect of protected research time on ABSITE scores during general surgery residency. Am J Surg 215(2):322–325. https://doi.org/10.1016/j.amjsurg.2017.11.001CrossRefPubMed

47.

Brochu A, Aggarwal R (2018) Research during general surgery residency: a Web-based review of opportunities, structure and outputs. J Surg Res 223:149–154. https://doi.org/10.1016/j.jss.2017.10.024CrossRefPubMed

48.

Khaitan A, Goswami K, Kant S, Gupta SK (2020) MD/MS thesis as a training tool. Indian J Public Health 64(2):201–203. https://doi.org/10.4103/ijph.IJPH_177_19CrossRefPubMed

49.

Gogate PM, Biswas P, Natarajan S, Nayak BK, Gopal S, Shah Y, Basak SK (2017) Residency evaluation and adherence design study: Young ophthalmologists’ perception of their residency programs II: Academics and Research dissertation. Indian J Ophthalmol 65(1):12–18. https://doi.org/10.4103/ijo.IJO_668_16CrossRefPubMedPubMedCentral

50.

https://www.nmc.org.in/MCIRest/open/getDocument?path=/Documents/Public/Portal/LatestNews/j.pdf. Accessed on 1^st November 2021

51.

Ghosh K, Ghosh K (2019) Medical Research in Medical College in India: Current Scenario and Ways to Improve it. J Assoc Physicians India 67(4):71–73PubMed

52.

Meier AH, Gruessner A, Cooney RN (2016) Using the ACGME milestones for resident self-evaluation and faculty engagement. J Surg Educ 73(6):e150–e157. https://doi.org/10.1016/j.jsurg.2016.09.001CrossRefPubMed

53.

http://www.absurgery.org/xfer/BookletofInfo-Surgery.pdf. Accessed on 1st November 2021

54.

https://www.jcie.org.uk/content/content.aspx?ID=1. Accessed on 1^st November 2021

55.

Harden RM, Stevenson M, Downie WW, Wilson G (1975) Assessment of clinical competence using objective structured examination. Br Med J. 1(5955):447–451CrossRef

56.

Moorthy K, Munz Y, Sarker SK, Darzi A (2003) Objective assessment of technical skills in surgery. BMJ 327(7422):1032–1037. https://doi.org/10.1136/bmj.327.7422.1032CrossRefPubMedPubMedCentral

57.

Dhar M, Gupta R, Rao S, Kant R (2021 Feb) Over-coming challenges in conducting postgraduate practical examination during COVID -19 pandemic. J Assoc Physicians India. 69(2):76PubMed

58.

https://www.nmc.org.in/information-desk/national-faculty-development-programme-new/. Accessed on 1^st November 2021

59.

Jain M (2019) National Medical Commission Bill: Opportunity to end educational apartheid? Indian. J Med Ethics. 4(3):254–255. https://doi.org/10.20529/IJME.2019.005CrossRef

60.

Poduval M (2010) Diplomate of the National Board: inefficient parallel education. Indian. J Med Ethics 7(1):22–25. https://doi.org/10.20529/IJME.2010.008CrossRef

61.

Sell NM, Phitayakorn R (2020) Developing and refining a surgical curriculum. Surgery 167(3):528–531. https://doi.org/10.1016/j.surg.2019.06.008CrossRefPubMed

62.

Khoushhal Z, Hussain MA, Greco E et al (2017) Prevalence and causes of attrition among surgical residents: a systematic review and meta-analysis. JAMA Surg 152(3):265–272. https://doi.org/10.1001/jamasurg.2016.4086CrossRefPubMed

63.

McHugh S, Corrigan M, Sheikh A, Lehane E, Tanner W, Hill A (2011) Factors influencing career choice after initial training in surgery. World J Surg 35(3):487–492. https://doi.org/10.1007/s00268-010-0934-1CrossRefPubMed

64.

Shah N, De Sousa AA (2018) Indemnity bonds for MBBS students: need for a change of perspective. Indian. J Med Ethics 3(3):1. https://doi.org/10.20529/IJME.2018.007CrossRef

65.

Gray K, Kaji AH, Wolfe M, Calhoun K, Amersi F, Donahue T, Smith BR, Salcedo ES, Murayama K, de Virgilio C (2020) Surgery Educators Workgroup. Influence of student loan debt on general surgery resident career and lifestyle decision-making. J Am Coll Surg 230(2):173–181. https://doi.org/10.1016/j.jamcollsurg.2019.10.016CrossRefPubMed

66.

Meyerson SL, Odell DD, Zwischenberger JB, Schuller M, Williams RG, Bohnen JD, Dunnington GL, Torbeck L, Mullen JT, Mandell SP, Choti MA, Foley E, Are C, Auyang E, Chipman J, Choi J, Meier AH, Smink DS, Terhune KP et al (2019) Procedural Learning and Safety Collaborative. The effect of gender on operative autonomy in general surgery residents. Surgery 166(5):738–743. https://doi.org/10.1016/j.surg.2019.06.006CrossRefPubMed

67.

Zerhouni YA, Abu-Bonsrah N, Mehes M, Goldstein S, Buyske J, Abdullah F (2015) General surgery education: a systematic review of training worldwide. Lancet 385(Suppl 2):S39. https://doi.org/10.1016/S0140-6736(15)60834-0CrossRefPubMed

68.

Rickard J (2016 Jun) Systematic review of postgraduate surgical education in low- and middle-income countries. World J Surg 40(6):1324–1335. https://doi.org/10.1007/s00268-016-3445-xCrossRefPubMed

69.

Jackson HT, Vaziri K, Bass BL (2021) Surgical education and training in the US: a collaborative effort to deliver the next generation of surgeons. Indian J Surg. 20:1–10. https://doi.org/10.1007/s12262-021-03080-xCrossRef

Titel: General Surgery Training in the USA, UK, and India: a Scrutiny of Strength and Challenges
verfasst von: Gaurav Jain
Chandrakanth Are
Vikesh Agrawal
Pawan Agarwal
Publikationsdatum: 17.01.2022
Verlag: Springer India
Erschienen in: Indian Journal of Surgery / Ausgabe Sonderheft 1/2022
Print ISSN: 0972-2068
Elektronische ISSN: 0973-9793
DOI: https://doi.org/10.1007/s12262-021-03226-x

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